Ultrasonographic evaluation of diaphragmatic function

International audienc

Analytic Solution of Emden-Fowler Equation and Critical Adsorption in Spherical Geometry

In the framework of mean-field theory the equation for the order-parameter profile in a spherically-symmetric geometry at the bulk critical point reduces to an Emden-Fowler problem. We obtain analytic solutions for the surface universality class of extraordinary transitions in $d=4$ for a spherical shell, which may serve as a starting point for a pertubative calculation. It is demonstrated that the solution correctly reproduces the Fisher-de Gennes effect in the limit of the parallel-plate geometry.Comment: (to be published in Z. Phys. B), 7 pages, 1 figure, uuencoded postscript file, 8-9

Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients

Objective: Use comparison with indirect calorimetry to confirm the ability of our previously described equation to predict resting energy expenditure in mechanically ventilated patients.Design: Prospective, validation study. Setting: Eighteen-bed, medical intensive care unit at a teaching hospital. Patients: All adult patients intubated >24 hrs were assessed for eligibility. Exclusion criteria were clinical situations that could contribute to erroneous calorimetric measurements. Interventions: Resting energy expenditure was calculated using the original Harris-Benedict equations and those corrected for usual stress factors, the Swinamer equation, the Fusco equation, the Ireton-Jones equation, and our equation: resting energy expenditure (kcal/day) = 8 × weight (kg) + 14 × height (cm) + 32 × minute ventilation (L/min) + 94 × temperature (°C) − 4834. Measurements and Main Results: Resting energy expenditure was measured by indirect calorimetry for the 45 included patients. Resting energy expenditure calculated with our predictive model correlated with the measured resting energy expenditure (r2 = .62, p < .0001), and Bland-Altman analysis showed a mean bias of −192 ± 277 kcal/day, with limits of agreement ranging from −735 to 351 kcal/day. Resting energy expenditure calculated with the Harris-Benedict equations was more weakly correlated with measured resting energy expenditure (r2 = .41, p < .0001), with Bland-Altman analysis showing a mean bias of 279 ± 346 kcal/day between them and the limits of agreement ranging from −399 to 957 kcal/day. Applying usual stress-correction factors to the Harris-Benedict equations generated wide variability, and the correlation with measured resting energy expenditure was poorer (r2 = .18, p < .0001), with Bland-Altman analysis showing a mean bias of −357 ± 750 kcal/day and limits of agreement ranging from −1827 to 1113 kcal/day. The use of the Swinamer, Fusco, or Ireton-Jones predictive methods yielded weaker correlation between calculated and measured resting energy expenditure (r2 = .41, p < .0001; r2 = .38, p < .0001; r2 = .39, p < .0001, respectively) than our equation, and Bland-Altman analysis showed no improvement in agreement and variability between methods. Conclusions: The Faisy equation, based on static (height), less stable (weight), and dynamic biometric variables (temperature and minute ventilation), provided precise and unbiased resting energy expenditure estimations in mechanically ventilated patients

Conformal Field Theory and Hyperbolic Geometry

We examine the correspondence between the conformal field theory of boundary operators and two-dimensional hyperbolic geometry. By consideration of domain boundaries in two-dimensional critical systems, and the invariance of the hyperbolic length, we motivate a reformulation of the basic equation of conformal covariance. The scale factors gain a new, physical interpretation. We exhibit a fully factored form for the three-point function. A doubly-infinite discrete series of central charges with limit c=-2 is discovered. A correspondence between the anomalous dimension and the angle of certain hyperbolic figures emerges. Note: email after 12/19: [email protected]: 7 pages (PlainTeX

Understanding hypoxemia on ECCO2R: back to the alveolar gas equation

Extracorporeal CO2 removal (ECCO2R) is a promising technique for ARDS and for severe acute exacerbations of COPD [1]. However, ECCO2R carries its own risk of complications and side effects. Beyond hemorrhagic and thrombotic complications and hemolysis, the occurrence of progressive hypoxemia has been reported in COPD patients treated by ECCO2R, leading to a tracheal intubation rate of 28% in the prospective series from Braune et al. [2]. Obviously, progressive hypoxemia can be explained by pulmonary complications such as evolving infiltrates, even if other factors such as modification of the respiratory quotient have been proposed [2, 3]. Accordingly, we illustrate such a mechanism, intrinsically linked to the ECCO2R technique and not involving any worsening of lung function by itself. A 76-year-old man was admitted because of a very severe hypercapnic acute exacerbation of a chronic respiratory failure due to non-cystic fibrosis bronchiectasis. Invasive mechanical ventilation..

Nonuniversal finite-size scaling in anisotropic systems

We study the bulk and finite-size critical behavior of the O$(n)$ symmetric $\phi^4$ theory with spatially anisotropic interactions of non-cubic symmetry in $d<4$ dimensions. In such systems of a given $(d,n)$ universality class, two-scale factor universality is absent in bulk correlation functions, and finite-size scaling functions including the Privman-Fisher scaling form of the free energy, the Binder cumulant ratio and the Casimir amplitude are shown to be nonuniversal. In particular it is shown that, for anisotropic confined systems, isotropy cannot be restored by an anisotropic scale transformation.Comment: 8 pages, 1 figure, accepted for publication in Phys. Rev. E and modifications of tex

Increased intensity of treatment and decreased mortality in elderly patients in an intensive care unit over a decade

Objectives: Data collected from two cohorts of patients aged ≥80 yrs and admitted to an intensive care unit in France were compared to determine whether intensive care unit care and survival had evolved from the 1990s to the 2000s.Design: Retrospective cohort study on patient data attained during intensive care unit stays. Setting: 18-bed intensive care unit in an academic medical center. Patients: Two cohorts of patients aged ≥80 yrs, admitted to an intensive care unit at a 10-yr interval. Interventions: None. Measurements and Main Results: The first cohort comprised 348 patients admitted between January 1992 and December 1995, and the second cohort, 373 patients admitted between January 2001 and December 2004. There was no difference in age between the two cohorts, but patients in the second had significantly less history of functional limitation and significantly more acute illness (Simplified Acute Physiology Score II 43 ± 18 vs. 57 ± 25, respectively, p &lt; .0001). Patients in the second cohort had a significantly higher Omega Score, had a higher occurrence of renal replacement therapy, and received vasopressors more frequently than the patients in the first cohort, even when adjusted for age, sex, Knaus classification, Simplified Acute Physiology Score II, and intensive care unit admission cause. Intensive care unit mortality was 65% and 64% for the first and second cohorts, respectively. In multivariate analysis (including age, Knaus classification, Simplified Acute Physiology Score II and first vs. second period) for association with intensive care unit survival, the 2001–2004 period was associated with a near tripling of chances of survival (odds ratio 2.9; 95% confidence interval, 1.92–4.47, p &lt; .0001). Conclusions: The characteristics and intensity of treatment for elderly people admitted to the intensive care unit changed significantly over a decade. The intensity of treatments has increased over time and survival has improved over time as well. A potential link between increased treatment and improved survival in the elderly may be evoked

On String Theory Duals of Lifshitz-like Fixed Points

We present type IIB supergravity solutions which are expected to be dual to certain Lifshitz-like fixed points with anisotropic scale invariance. They are expected to describe a class of D3-D7 systems and their finite temperature generalizations are straightforward. We show that there exist solutions that interpolate between these anisotropic solutions in the IR and the standard AdS5 solutions in the UV. This predicts anisotropic RG flows from familiar isotropic fixed points to anisotropic ones. In our case, these RG flows are triggered by a non-zero theta-angle in Yang-Mills theories that linearly depends on one of the spatial coordinates. We study the perturbations around these backgrounds and discuss the possibility of instability. We also holographically compute their thermal entropies, viscosities, and entanglement entropies.Comment: 47 pages, 4 figure

Von Willebrand factor is a major determinant of ADAMTS-13 decrease during mouse sepsis induced by cecum ligation and puncture

Summary. Background: During sepsis, von Willebrand factor (VWF) is abundantly secreted; the main mechanism regulating its size involves specific proteolysis by the metalloprotease ADAMTS-13. Objectives: To determine whether ADAMTS-13 consumption due to its binding to, and/or cleavage, of VWF contributes to its decrease during sepsis and whether abrogating or enhancing ADAMTS-13 activity influences sepsis outcome. Methods: ADAMTS-13 activity was evaluated in a model of sepsis induced by cecum ligature and puncture (CLP) in wild-type and Vwf−/− mice. Sepsis outcome was studied in those mice and in Adamts-13−/− mice. Finally, survival was studied in wild-type mice injected hydrodynamically with the human ADAMTS-13 gene. Results: In wild-type mice, CLP-induced sepsis elicited a significant ADAMTS-13 decrease, and a strong negative correlation existed between VWF and ADAMTS-13. In Vwf−/− mice, CLP also induced severe sepsis, but ADAMTS-13 was not significantly diminished. Notably, Vwf−/− mice lived significantly longer than wild-type mice. In contrast, Adamts-13−/− mice and wild-type mice were comparable with regard to thrombocytopenia, VWF concentrations, absence of thrombi, and survival. Hydrodynamic hADAMTS-13 gene transfer with the pLIVE expression vector resulted in high and stable ADAMTS13 activity in CLP mice; however, no impact on survival was observed. Conclusions: VWF secretion is a major determinant of ADAMTS-13 decrease in the CLP model, and plays an important role in sepsis-induced mortality, but the complete absence of its regulating protease, ADAMTS-13, had no detectable impact in this sepsis model. Furthermore, increasing ADAMTS-13 activity had no impact on survival

Assessment of the interplay between blood and skin vascular abnormalities in adult purpura fulminans

RATIONALE: Purpura fulminans in adults is a rare but devastating disease. Its pathophysiology is not well known. OBJECTIVES: To understand the pathophysiology of skin lesions in purpura fulminans, the interplay between circulating blood and vascular alterations was assessed. METHODS: Prospective multicenter study in four intensive care units. Patients with severe sepsis without skin lesions were recruited as control subjects. MEASUREMENTS AND MAIN RESULTS: Twenty patients with severe sepsis and purpura fulminans were recruited for blood sampling, and skin biopsy was performed in deceased patients. High severity of disease and mortality rates (80%) was observed. Skin biopsies in purpura fulminans lesions revealed thrombosis and extensive vascular damage: vascular congestion and dilation, endothelial necrosis, alteration of markers of endothelial integrity (CD31) and of the protein C pathway receptors (endothelial protein C receptor, thrombomodulin). Elevated plasminogen activating inhibitor-1 mRNA was also observed. Comparison with control patients showed that these lesions were specific to purpura fulminans. By contrast, no difference was observed for blood hemostasis parameters, including soluble thrombomodulin, activated protein C, and disseminated intravascular coagulation markers. Bacterial presence at the vascular wall was observed specifically in areas of vascular damage in eight of nine patients tested (including patients with Streptococcus pneumoniae, Neisseria meningitidis, Escherichia coli, and Pseudomonas aeruginosa infection). CONCLUSIONS: Thrombi and extensive vascular damage with multifaceted prothrombotic local imbalance are characteristics of purpura fulminans. A "vascular wall infection" hypothesis, responsible for endothelial damage and subsequent skin lesions, can be put forward